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• SAN JOAQUIN COUNTY to <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax: (209) 468-3433 Web:www.sigov.om/ehd <br /> RECORDING REQUIREMENTS <br /> FOR UNAUTHORIZED RELEASES <br /> An owner or operator is required to record all releases from the primary containment, ,as approved in <br /> this facility's Response Plan. This form may be used to meet the recording requirements* if all of the <br /> conditions below are true. <br /> 1. The owner or operator can clean up the release from the primary containment /T!)k <br /> within 8 hours after the release was detected or should have been detected. F <br /> AND <br /> 2. The release has not escaped the secondary containment. F <br /> AND <br /> 3. The release does not increase the hazard of fire or explosion. F <br /> AND <br /> 4. The release does not cause deterioration of the secondary containment. r F <br /> If all conditions above are not fulfilledyou must report the release to the San Joaquin County <br /> Environmental Health Department and other agencies as appropriate. Date of release: !91is-161 <br /> Operator's name: ai i r+ 06J e 1-4 UI Phone Number: qtLIL�70 <br /> A I- <br /> Facility name: Lecava Facility Address: W4 C <br /> Lrc <br /> Hazardous substance found in the secondary containment: \-ese( <br /> Quantity: fg)cAw) Concentration: <br /> Description of t actions taken to control and clean up the rele Z <br /> ve( su/no <br /> !VUMVVd i-7out of -+W0 <br /> The method and locatiQn of dis osal of th rel ased hazardous substance: <br /> 1401 r< -Ful, t I <br /> Description of actions taken to repair the UST and to prevent future releases. Attach a copy of the <br /> (-A <br /> maintenance receipt:_ -1 tTl t n!j) U,-\o <br /> U <br /> Describe how the monitoring system was reactivated after repairs or replacement: <br /> vS <br /> hao tepaS V S Qjv-, -neee%,(a r <br /> Attach printout from continuous monitoring system, maintenance receipts, manifests, photos, etc. <br /> Retain this document with your monitoring records for review during the annual inspection by our department. <br /> *See the California Code of Regulations, Title 23, Section 2651 and California Health &Safety Code Section <br /> 25294 for further requirements. <br />